Nursing faculty use ‘critical incident’ teaching
strategy

Hank, a surgery patient, buzzes the desk to ask for his pain medication. He
received a dose 15 minutes ago. The physician declines to order more pain
medication or change the prescription. What should the nurse do?

Alison is a strong-willed 15-year-old asthma patient who is recovering from a
serious bronchial infection. She insists on leaving the ward without
the aid of a wheelchair. What is the nurse’s responsibility?

Ben, a patient with advanced
cancer, falls in his hospital room
during the night. He breaks a bone. What preventive measures should have been
taken?

A University Hospital intensive care nurse adjusts an airway tube in a
patient.

The medical-surgical nurse faces situations such as these on a daily basis.
Nursing students also experience such incidents with concerns about patient
advocacy and professional competence. Several faculty members in the School of
Nursing have begun teaching their baccalaureate students a strategy for critical
thinking utilizing "critical incident" situations.

"Understaffing and multiple-patient loads are common today, and half of
all critical incidents involve medications," says Dr. Mary Heye, a
registered
nurse and associate professor in the Department of Acute Nursing Care. "We
are teaching students to talk about patient and health care professional
encounters that are a source of dilemma, in an effort to increase their
problem-solving ability and reflection on steps to take in such situations. The
questions are, ‘What happened here?’ ‘Who was responsible?’ and ‘What
could have
been done?’"

Students have discussed 150 scenarios of incidents with profound
implications. The learning strategy, developed by S. Kay Thornhill and Melissa
Wafer of the School of Nursing at Southeastern Louisiana University, involves
six steps:

Identify the critical incident,

Note personal experience,

Identify and challenge assumptions,

Challenge the importance of context,

Explore alternatives, and

Identify issues impacting
professional practice.

Dr. Heye and faculty colleagues
Dr. Margaret Bell, Laura Campion, Barbara Owens, Pauline Hendricks and Janemarie
Schoonover, all registered nurses, began their work with first-semester nursing
students. "Studying actual critical incidents helps us highlight current
issues and the role of the professional nurse as provider of care," Dr.
Heye says. "Using this strategy provided a model that is easily described
and discussed by both students and faculty."

Faculty analyzed three sets of data using content analysis. The first set
involved critical incident scenarios submitted by the students, the second
addressed students’ written
responses to four personal
experience questions and the
third consisted of faculty recordings
of each clinical group’s discussion of
a selected critical incident.

Dr. Heye and her colleagues presented the preliminary findings
at two national nursing meetings.

"Students’ descriptions of these critical incidents more often
portrayed negative than positive situations, and caring and uncaring emerged as
common themes," the authors wrote
in a project summary.

"Individual responses to the selected critical incidents demonstrate the
professional socialization conflicts that challenge beginning nursing
students," the authors continued.

Investigation of this learning strategy will be continued in future clinical
groups and will be extended to include senior students to provide data for
comparative analysis, Dr. Heye says.